MEDICARE: LAKESHORE NEUROWELLNESS & REHAB CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1144165911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE NEUROWELLNESS & REHAB CENTER LLC

Provider Business Mailing Address
First Line	:	10750 W HOWARD AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-1321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10750 W HOWARD AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53228-1321
Country	:	US
Telephone Number	:	414-239-6248
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTORY
Name	:	CHRISTOPHER CRONSELL
Credential	:	MD
Telephone Number	:	773-209-8464

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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